Register for a Clinic

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Virtual Clinic Registration Form

Use this form to register for our virtual clinics.

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Daytime Phone*
Cell Phone
Sharing your cell phone number with us is important as it may help us communicate with you during a Clinic
Clinic Information
- Saturday, October 3, 2020 [12 Noon-4 pm ET]
- Saturday, October 17, 2020 [12 Noon-4 pm ET]
- Saturday, November 7, 2020 [12 Noon-4 pm ET]
If you register for the Virtual Clinics, you can attend as few or as many of the 3 days as you wish.
How many BPT (or similar) weekend clinics have you previously attended?
Please enter a number from 0 to 30.
Pilot Registration for Virtual Clinic*
- Virtual Clinics Only ($500)
- Flying Only ($495)
- Virtual Clinics with Flying ($995)
Aircraft Information
Aircraft Type
Aircraft N#*
Year aircraft built
Dual Controls?*
- Yes - dual control yoke
- No - single control yoke
Turbocharged/Turbonormalized?
- Yes
Allison Turboprop?
- Yes
What GPS, Autopilot, MFD or other special equipment does your aircraft have?
Are you sharing an aircraft with another attendee? If so please provide his/her name
Please answer the following questions about your flight time
Estimated total time*
Bonanza time
Baron/Travel Air/Duchess time
Duke time
Are you instrument rated?*
- Yes
- No
Pilot Certificate Number*
Insurance & Documents we must receive from you before your flight, if you choose to fly later:
- Insurance Certificate naming BPT Inc. as an additional insured AND a waiver of subrogation
The above should be sent to our insurance manager:

Pam Bailey
Email: registrar@pbpt.org

On the day of your flight you will sign a Hold Harmless Agreement and complete a PIC Statement
Cancellation Policy
If you cancel more than 3 weeks before the program begins, you can receive a full refund less a $100 service fee for refunds greater than $1000. If you cancel within 3 weeks of when the program begins, you may either take another program within 12 months with a $150.00 transfer fee, or receive a 50% refund.
Grand Total
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Comments
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Register for a Clinic

Take a minute. Take our survey.

Virtual Clinic Registration Form

Clinic Information

Aircraft Information

Please answer the following questions about your flight time

Insurance & Documents we must receive from you before your flight, if you choose to fly later:

Cancellation Policy